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VA program invites veterans to share their stories

  • Joanne Belviso Puckett, of Hanover, a former VA Medical Center chief quality officer, interviews Ruth Morrison, of Waits River, for the "My Life, My Story" program at the hospital in White River Junction, Vt., Wednesday, Dec. 4, 2019. A transcript from the interview with Morrison, who served in the Navy in World War II, will be edited and added to her medical record to give her providers some context and insight into her life experience. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Ruth Morrison, 95, of Waits River, left, shows Joanne Belviso Puckett, of Hanover, a necklace pendant made from her and her husband's wedding rings after an interview for the "My Life, My Story" program at the VA Medical Center in White River Junction, Vt., Wednesday, Dec. 4, 2019. During the interview Morrison shared stories of her experience serving in the Navy in World War II, her current living situation and her expectation to live to age 103. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Valley News Staff Writer
Published: 12/5/2019 10:06:00 PM
Modified: 12/6/2019 11:47:12 AM

WHITE RIVER JUNCTION — Ruth Morrison is 95 and lives in the Waits River, Vt., home where she moved after giving birth to the fourth of her five children decades ago.

This independence late in life is possible because one daughter lives nearby and brings her meals to heat up in the microwave. Another daughter drives her to appointments at the White River Junction VA Medical Center.

Morrison, who served in the Navy during World War II, shared these details of her life during an interview Wednesday with Joanne Belviso Puckett, a former chief quality officer at the VA Medical Center who has come out of retirement to conduct such interviews as part of a VA program called “My Life, My Story.”

Morrison, who sat under a blanket in a hospital bed at the VA with her 65-year-old daughter Margy Bruce, of Brandon, Vt., at her side, told Puckett she aims to live to at least 103 in order to best a great-grandmother who lived to 102. She has arthritis and some vision issues and comes in for a regular iron infusion to treat anemia, but she wasn’t complaining.

“I really think I have had a good life,” she said. “I’m very lucky at this age to be as well as I am and still in my own home by myself.”

After the interview, including this glimpse into Morrison’s living situation that might offer providers a sense of whether she has the support she needs to live alone, Puckett will transcribe the story and send it back to Morrison for her approval before attaching it to her electronic medical record. Once it’s attached, all members of a veteran’s care team can read the first-person story and understand more about the veteran’s goals for their care and life.

“I have no other agenda, except to listen,” Puckett said.

The national program, which originated in 2013 at the William S. Middleton Memorial Veterans Hospital in Madison, Wis., aims to give veterans the chance to share their life stories with their medical providers in an effort to re-create the connection people historically had with their family doctor. The program has since been recommended by the VA’s Office of Veterans Experience for implementation across the country, but it isn’t mandatory.

The program came to the White River Junction VA a few years ago. Dr. Joel Bradley, now a VA hospitalist and a pediatrician at the Children’s Hospital at Dartmouth, took on the project during a quality improvement fellowship at the White River Junction VA in 2016 and 2017, under the mentorship of Dr. Emily Cohen, who is the White River Junction VA’s associate chief of primary care.

Gregory Robben, who now works at the VA medical center in Boston, joined the project in 2017 as a quality improvement intern while he was an undergraduate at the University of Vermont.

In addition to creating the program that Puckett — a trained nurse with a master’s degree in counseling — picked up this summer, the team created a modified version, called “Healing Through History,” which is now part of the four-week ambulatory medicine rotation that internal medicine residents at Dartmouth-Hitchcock do at the White River Junction VA and is supported by a “Back to Bedside” grant from the Accreditation Council for Graduate Medical Education.

This modified program focuses on veterans with socially or medically complex conditions that make them high-risk for re-admission. Each resident is responsible for interviewing a veteran and taking a complete social history, which they then attach to the medical record. “Healing Through History” differs from “My Life, My Story” in who is doing the interviews and in that the story is written in the third person and includes care recommendations that the resident and the patient develop together.

The residents, about two per month, spend an average of two hours talking with veterans, who agree to participate, about issues such as their finances, housing, food security, relationship with the health care system, trust, communication preferences, home environment, substance use and mobility challenges.

The idea is to help patients avoid repeated hospital admissions by better meeting their needs in an outpatient setting, which Bradley said is “cheaper and better for everyone.”

While getting a social history is “very much a part of normal practice,” Bradley said, the residents’ interviews are “really thorough.”

For example, while providers commonly ask veterans in which branch of the military they served, the residents will try to learn “what that might have been like,” Bradley said.

Patients are often identified through referrals from providers who think the patient and their care team might benefit from having a more complete history on file.

Though they haven’t studied how the program affects patient care and the patient/provider relationship, Bradley said there are examples of ways in which the project has made a difference.

For example, Bradley said one interview found that a patient had been placed on oxygen, but it was unclear why. Another found that a patient with liver disease who used alcohol was reluctant to go to the hospital. In other cases, the interviews have highlighted undiagnosed cases of post-traumatic stress disorder or chemical exposures, such as to Agent Orange, or situations in which veterans would benefit from reconnecting with family and friends they’ve lost touch with.

The interviews also have helped the residents to point the veterans to resources, such as physical therapy, occupational therapy, home-based primary care or recreational therapy such as horseback riding, sled hockey or other things “that would really bring this patient joy,” Cohen said.

Broadly, Bradley said the project helps residents to explore the questions of: “Do I really know my patient?” and “How well should I know my patients?”

For their own part, Bradley and Cohen said they’re certain that participating in the program has helped their work.

“I definitely feel like I listen better,” Cohen said.

After finding herself “bored to tears” by retirement, the 68-year-old Puckett picked up the “My Life, My Story” program this summer and has conducted 15 interviews so far. She describes the part-time work as her “post-retirement dream job” and said her biggest challenge is in editing the veterans’ stories down to the recommended length of 1,000 words.

“I have not gotten to that 1,000 words yet,” she said. “If this is important enough to the veteran, I’m going to write it.”

In addition to linking the transcribed interviews to the electronic medical record, Puckett also gives veterans copies of the interview on VA letterhead.

Morrison — who moved back to Vermont after World War II, served as Topsham’s town clerk for nearly 30 years, held numerous other offices in town and authored a history of the town — said, “I don’t think I have any wisdom in me.”

But she asked for copies of the interview for herself, her four living children and her eight grandchildren.

Those interested in participating — either as veterans or volunteers — can contact Puckett at Joanne.Puckett@va.gov or 802-295-9363 ext. 5390.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

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